Professor Fergal Malone:

The Senator referred to the prospect of more integrated services, perhaps at the primary care level and earlier in pregnancy. We are strong supporters of that concept. We want normal obstetrics to be delivered in the community as much as possible, by midwives and GPs, with the involvement of hospital obstetricians occurring only on an as-needed basis. That is the more efficient way to do things. However, that does leave open the potential, as the Senator observed, for situations where the local GP has a conscientious objection. The Medical Council is clear on this in that while doctors are entitled and allowed to have their own personal viewpoints and conscientious objections, there is an obligation on a doctor to ensure a patient is not disadvantaged as a consequence of any such view or objection. In such cases, there is an obligation to refer the patient to another doctor. I hope that would be done as efficiently as possible.

On the factors which dictate which patients receive scans, a crucial concept with foetal anomaly scanning is that it needs to be provided to all patients. Only a minority of foetal abnormalities occur in the setting of a previously affected pregnancy or a patient who has a strong family history. The vast majority of foetal abnormalities occur on a once-off basis where the couple in question had no previous idea such a problem might arise. We will only find those abnormalities if the scan is made available equally to everyone. It is not appropriate and not efficient to take just a certain age group or a certain disease category and provide a scan for those patients. That is one of the challenges we have in our health care system at the moment. In the RCSI hospital group, for example, of which the Rotunda is part, a new programme has been rolling out over the past month to resource foetal anomaly scans for Cavan General Hospital and Our Lady of Lourdes Hospital by way of the provision of a certain number of contract hours by newly appointed hospital group staff at those locations. We will see some improvements in that regard but it is a major deficit of the Irish health care system at this time.